Department of Pediatric Oncology, Children's Cancer Hospital Egypt (57357), 11511, Cairo, Egypt.
Department of Pediatric Oncology, National Cancer Institute, Cairo University, 11511, Cairo, Egypt.
Med Mycol. 2022 Apr 6;60(4). doi: 10.1093/mmy/myac010.
Invasive fungal sinusitis (IFS) is a rare disease that requires careful attention and prompts management due to its high mortality among pediatric patients with hematological malignancies. This is a retrospective analysis of pediatric patients with hematological malignancies treated at Children's Cancer Hospital Egypt 57 357 (CCHE) through the period from 2008 till 2016 with proven IFS. Thirty-four patients were diagnosed with IFS. Five (15%) patients had an invasive rhino-cerebral fungal disease. Mucorales were isolated in 50% (n = 17) patients, Aspergillus in 38% (n = 13) patients, and mixed fungal in 12% (n = 4) patients. Sinuses were the only localized site in (45%). Extra-nasal spread was reported in 20 patients; Sino-pulmonary in 35% (n = 12), sino-cerebral in 15% (n = 5), and sino-orbital in 5% (n = 2) patients. Combined antifungal therapy with surgical debridement was done in 59% of patients with a better outcome when compared to those who received only medical antifungal treatment (P = .01). The overall mortality rate at week 12 was 35% (n = 12), and IFS attributable mortality was 20% (n = 7). IFS with cerebral extension carried the highest mortality rate for both 12-week all-cause (P = .04) and fungal-attributable (P = .01) mortality. Pediatric patients with hematologic malignancies are susceptible to invasive fungal sinusitis (IFS). Surgical debridement, combined with antifungal therapy, improves outcomes among those patients. IFS patients with cerebral extension had a higher risk of mortality.
We studied the characteristics of invasive fungal sinusitis in children with hematological malignancies. Mucormycosis was the most common cause. Surgical debridement, combined with anti-fungal therapy, improves outcomes. Patients with rhino-cerebral fungal disease had a higher risk of mortality.
探讨儿童血液系统恶性肿瘤侵袭性真菌性鼻窦炎（IFS）的临床特征。
回顾性分析 2008 年至 2016 年在埃及儿童癌症医院（CCHE）治疗的 34 例儿童血液系统恶性肿瘤 IFS 患者的临床资料。
共确诊 IFS 患者 34 例，其中侵袭性鼻窦-颅真菌病 5 例（15%）。分离出毛霉科真菌 50%（n=17）、曲霉菌 38%（n=13）和混合真菌 12%（n=4）。单纯鼻窦感染占 45%（n=15），鼻腔外播散 20 例（63%），其中肺鼻窦播散 35%（n=12）、鼻窦-脑播散 15%（n=5）、鼻窦-眼眶播散 5%（n=2）。59%（n=20）的患者接受联合抗真菌药物治疗和手术清创，与单纯抗真菌治疗相比，预后更好（P=0.01）。12 周时总死亡率为 35%（n=12），IFS 相关死亡率为 20%（n=7）。具有脑侵犯的 IFS 在 12 周全因死亡率（P=0.04）和真菌相关死亡率（P=0.01）方面均具有最高死亡率。
儿童血液系统恶性肿瘤患者易患侵袭性真菌性鼻窦炎，联合抗真菌药物治疗和手术清创可改善预后。具有脑侵犯的 IFS 患者死亡率较高。
